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Predictors of symptomatic and functional outcome after a first episode of psychosis:towards the construction of a prognostic model.

(2017)Brink, V. (Vera)

INTRODUCTION The notion that psychotic disorders are deteriorating, life-long diseases, has been revised during the last two decades. Currently, a more optimistic view on the outcome of patients after a first episode of psychosis (FEP) is being put forward. Nevertheless, there is still a large group of FEP patients that does not reach remission. In order to improve the probability of remission, early individualized intervention is needed. Patients who need more intensive treatment early in the disease can be identified with outcome predictors. More knowledge of these predictors, however, has to be gathered. Therefore, this study aims to reevaluate currently accepted predictors and to identify yet unknown predictors of symptomatic and functional outcome after a FEP in a longitudinal naturalistic patient cohort.
METHODS Data from 408 affective and non-affective FEP patients enrolled in both the ‘Psychosis Recent Onset GRoningen Survey’ (PROGR-S) and the ‘Pharmacotherapy Outcome and Monitoring Survey’ (PHAMOUS) was analyzed. These naturalistic prospective cohort studies provided socio-demographic, premorbid, diagnostic, clinical and cognitive baseline characteristics, and yearly follow-up measurements respectively. Associations between the potential predictors and poor symptomatic and functional remission between baseline and 5 years (short/medium-term) and between 5 and 17 years (long-term) after inclusion were investigated with uni- and multivariable logistic regression analyses.
RESULTS In the current study, 184 patients were included in the short/medium-term outcome analysis and 239 patients were included in the long-term outcome analysis. More negative symptoms were associated with poor short/medium-term symptomatic (OR=1.16, 95%CI=1.01-1.33, p=0.040) and functional outcome (OR=1.32, 95%CI=1.11-1.57, p=0.002). Poor overall role functioning (OR=1.18, 95%CI=1.04-1.35, p=0.014), using less reassuring thoughts as coping style (OR=0.75, 95%CI=0.60-0.95, p=0.015), poor recognition memory (OR=0.72, 95%CI=0.54-0.96, p=0.024) and poor global functioning (OR=0.96, 95%CI=0.92-1.00, p=0.037) predicted poor long-term symptomatic outcome. More negative symptoms (OR=1.08, 95%CI=1.00-1.16, p=0.047) and having repeated a grade (OR=0.96, 95%CI=0.92-1.00, p=0.037) were associated with poor long-term functional outcome.
CONCLUSION This study identified variables associated with poor symptomatic and functional outcome after a FEP. Knowledge of outcome predictors contributes to the future development of a risk calculator that enables clinicians to make individualized treatment plans based on the probability of poor functional or symptomatic outcome.